A LPHA is defined as the governmental public health presence at the local level. It may be a locally-governed health department; a branch of the state health department; a state-created district or region; a department governed by and serving a multi-county area; or any other arrangement that has governmental authority and is responsible for public health functions at the local level.

All local public health agencies (LPHAs), as governmental entities, derive their authority and responsibility from the state and local laws that govern them. Accordingly, all LPHAs exist for the common good and are responsible for demonstrating strong leadership in the promotion of social, economic and environmental conditions that improve health and wellbeing and prevent illness, disease and injury. However, in the absence of specific, consistent standards regarding how LPHAs fulfill this responsibility, the degree to which the public's health is protected and improved varies widely from community to community. This definition is composed of standards, framed around the nationally-recognized Ten Essential Public Health Services, that describe what every person, regardless of where they live, should reasonably expect their LPHA to meet. The standards provide a framework by which LPHAs are accountable to the public they serve and to the governing bodies (e.g., local boards of health) to which they report. In meeting the standards, it is imperative that LPHAs operate according to the highest level of professionalism and ethics to inspire public confidence and trust.

The capacity and the authority of the governmental public health presence at the local level vary widely, and as a result, how LPHAs perform public health functions to meet the standards will also vary. For example, with respect to capacity, the LPHA may perform all of the functions on its own; it may call upon the state to provide assistance for some functions; it may develop arrangements with other organizations in the community or with neighboring LPHAs to perform some functions; or it may control the means by which other organizations perform some functions. With respect to authority, sometimes other governmental entities perform some public health functions (e.g., environmental health). In these instances, the LPHA continues to have a leadership role in meeting the standards associated with the functions: the LPHA informs and influences the other governmental efforts, identifies any shortcomings in meeting the associated standards, and leads efforts to fill in gaps.

Regardless of the capacity and specific authority of the LPHA in any community, however, their responsibility to lead governmental public health in meeting the standards is constant. The standards are intended to provide consistency with respect to the fundamental functions performed by LPHAs, but the structural characteristics of LPHAs (e.g., governance, staffing patterns, size of the population served, etc.) will continue to vary, and each LPHA may be required to perform functions unique to meeting the public health needs of the community it serves. Finally, embedded throughout the definition are ways in which the LPHA works with other members of the local public health system (comprising all those entities that contribute to the public’s health, e.g., public and private health care providers, community organizations, schools, media, and businesses). LPHAs are the natural leaders in the development of a cohesive local public health system, working at times as leader, convener, partner, collaborator, enabler, or evaluator. For the purposes of this definition, a LPHA is defined as the governmental public health presence at the local level. It may be a locally-governed health department; a branch of the state health department; a state-created district or region; a department governed by and serving a multi-county area; or any other arrangement that has governmental authority and is responsible for public health functions at the local level.